Core Rotations in Hematopathology:
Hematopathology Lymph Node/Bone Marrow Service
The hematopathology rotation includes lymph node examinations, bone marrow core biopsies, fine needle aspiration biopsies, surface marker studies including immunofluorescence and immunoperoxidase techniques, flow cytometry, electron microscopy, DNA ploidy analysis and molecular genetic applications. This provides experience in diagnostic hematopathology and acquaints the fellow with a wide range of ancillary laboratory procedures that can be used both to confirm morphologic diagnoses and to provide tools for investigative studies in hematologic diseases. The fellow is responsible for handling all specimens on patients with known or suspected hematolymphoid malignancies including gross description, preparation of frozen section for intraoperative consultation as well as tissue allocation for routine histology and ancillary studies. All cases are reviewed by the fellow independently, and are subsequently presented to the hematopathology attending for sign-out. Relevant clinical data, results of immunoperoxidase studies, DNA ploidy, flow cytometric analysis and molecular genetic studies are discussed in conjunction with routine histology for arriving at the final diagnosis. In addition, the fellow assist the resident and serves as a consultant on all autopsies in which hematologic disease is a concern.
The goal of this rotation is for the fellow to develop a sound knowledge of major aspects of laboratory hematology. A major feature of this rotation includes daily supervised evaluation of abnormal and problematic blood smears, bone marrow aspirates including the special stains used in the evaluation of leukemias. The fellow first independently reviews all bone marrow aspirates coming through the laboratory and a written report is prepared for final sign-out with the attending. In addition, the fellow is expected to interpret serum, urine, and CSF protein electrophoresis, and related immunofixation tests.
The rotation in cytogenetics will lead to familiarity with specimen procurement, handling, accessioning and preservation. There will be hands-on experience with bone marrow and peripheral blood specimens and will be exposed to culture, harvest, staining, microscopy and karyotyping. The fellow will have an introduction to cytogenetics nomenclature and chromosome banding techniques, and exposure to cell harvesting methodologies for tissue, blood and bone marrow specimens. The fellow will also be exposed to molecular cytogenetics techniques using fluorescent in-situ hybridization (FISH).
During the flow cytometry rotation the fellow is introduced to the basic operation of the laboratory, instrument operation, specimen processing and analysis, results interpretation and reporting, and all related quality control involved in clinical flow cytometry assays. Hands-on experience permits understanding of specimen processing and analysis. All reports generated during the rotation are reviewed with the fellow and the clinical significance of the flow cytometric findings is discussed. Instruction is provided in interpretation of gates, dot plots, and histograms. In addition, instruction in interpretation of immunophenotypes is provided and emphasized, and the limitations and pitfalls of flow analysis are explained. Case studies are utilized to expand understanding of interpretation of immunophenotypes in lymphomas and leukemias. Specific diseases represented among specimens tested include various examples of non-Hodgkin's lymphoma, reactive lymphoid proliferations, lymphoproliferative disorders, myeloid, lymphoid, monocytic and megakaryocytic leukemias, acquired and primary immunodeficiencies and granulocyte disorders.
This rotation is designed to provide an opportunity for the fellow to acquire knowledge of the specimen procurement, specimen preservation, specimen preparation and molecular genetic testing performed in the molecular diagnostics laboratory and its clinical applications. The fellow will review various diagnostic procedures, instrument manuals and other reference materials and discuss the interpretative aspect of the test procedure with the laboratory technical supervisory staff. There is exposure to molecular diagnostic techniques including DNA extraction, gel electrophoresis, Southern transfer, probe hybridization and the polymerase chain reaction. Additional exposure is accomplished through participation in molecular based assays that are components of departmental research. Fellows also assist in the development of new diagnostic molecular assays.